What to do if the follicle does not rupture

Unruptured follicles are a condition in which the follicles are abnormal. After this happens, it can be caused by many reasons, including immature follicles, or some other reasons may lead to unruptured follicles. Once unruptured follicles occur, we should take some measures to treat them, such as surgical treatment, etc. So what should we do if the follicles do not rupture?

Once the follicle matures, at the peak of luteinizing hormone (LH) or 48 hours after injection of human chorionic gonadotropin (HCG), ultrasound shows that the follicle is still there, has not collapsed or disappeared, and the egg has not been discharged from the follicle. This is LUFS. These patients also have normal menstrual cycles and changes in cervical mucus that give the false impression of ovulation. After the follicle is luteinized, it still secretes progesterone, and the basal body temperature remains elevated in the second half of the menstrual period. It is not easy to detect without ultrasound monitoring. Among people who monitor ovulation, the incidence of LUFS is about 10%, and the incidence rate among infertile people is about 25-40%. LUFS is a special type of ovulation disorder, not an independent disease, and is mostly treated causally.

Expectant treatment: LUFS occurs accidentally in some patients. For patients with no history of infertility or who discover LUFS for the first time, the lutein cyst sometimes disappears naturally before the next menstruation and does not need to be treated for the time being.

Treatment of primary disease: For patients with concurrent diseases such as hyperprolactinemia, PCOS, endometriosis, chronic pelvic inflammatory disease, etc., after a clear diagnosis, medication or surgery will be given to treat the primary disease.

Drug-induced follicle rupture: Individualized ovulation induction plan is formulated and optimized, and after the follicles mature, high-dose HCG or short-acting GnRH-a is injected alone or in combination.

Mechanical treatment: 48 hours after the drug-induced follicle rupture, if the follicle still exists, the follicle can be gently and moderately squeezed by hand under ultrasound guidance. If the follicle still does not rupture, follicle puncture surgery can be performed through the posterior fornix of the vagina under ultrasound guidance to help the egg rupture and be discharged, while also guiding sexual intercourse to try for pregnancy. However, the moderate compression method has limited effect, the puncture method is not cost-effective, and there may be risks such as potential damage and infection, so it is not widely used in clinical practice.

Laparoscopic surgery: Laparoscopic surgery is used to improve the pelvic environment and restore normal structure. Moderate ovarian drilling for patients with PCOS can reduce the secretion of androgen, increase feedback to the hypothalamus and pituitary gland, and induce follicle rupture; if combined with severe endometriosis or pelvic adhesions, the adhesions can be loosened.

IVF: Patients who still fail to conceive after using the above methods or who have recurrent LUFS are recommended to consider IVF treatment. Through egg retrieval surgery, the eggs are removed and fertilized with sperm in vitro to solve the fertility problem.

Psychological treatment: Relaxation and psychological counseling when necessary can help restore normal ovulation.

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